By Lindsay Castleberry

Dr. Erin Farabaugh Cassilly, who graduated from the University of Maryland School of Dentistry in 2012, moved to Lexington in the summer of 2013 to begin her career at the Rockbridge Area Health Center.

Bringing a dentistry practice into the area’s public schools for the first time, she quickly discovered how teeth problems among the poor and uninsured are connected with so many other problems.

“I was kind of ignorant to disparities of health care,” she said. “I’m not from around here, but I’ve come to realize that there are plenty of patients who can’t afford to pay for gas to even get to a dentist.”

Many students in Rockbridge County had never seen a dentist before the health center launched the school program in the fall of 2013. Now in its second year, the program began its weekly spring visits on Tuesday at Fairfield Elementary. On March 24 it will go to Enderly Heights Elementary in Buena Vista.

The program is called HORSES, for Health, Oral care, Reduction in cavities, School-based setting, Evaluations and Sealants. The health clinic teams up with schools in Rockbridge County, Lexington and Buena Vista to make dental care more accessible for low-income children.

More than just a toothache

Tooth decay is said to be the most common chronic disease in children. Dental diseases account for 1 million lost school hours in Virginia each year, according to the American Academy of Pediatric Dentistry. The Pew Charitable Trusts reported that in California alone approximately 504,000 children missed at least one school day in 2007 because of a toothache or other oral health concerns. These absences were also linked to weaker academic performance.

When Cassilly came to the health center, she was part of other changes at the clinic. The county had conducted a health needs assessment in 2012. Partly in response to that study, the former Rockbridge Area Free Clinic became the Rockbridge Area Health Center, with federal qualification. It still serves the uninsured and under-served of all ages, but in some cases it now charges patients on a sliding scale.

Cassilly, the clinic’s first full-time paid dentist, replaced volunteer dentists. She said volunteer dentists would present legal problems for a federally qualified center.

The health center brings HORSES into each of the Rockbridge area’s 12 public schools once each fall and once each spring.

Cassilly works with two dental assistants and a dental program manager who coordinates HORSES.

Dr. Erin Farabaugh Cassilly works on a young patient. Photo courtesy of Rockbridge Area Health Center

By visiting the schools and bringing in dental equipment to set up a mobile examining unit for the day, HORSES is addressing the transportation problem that many families in Rockbridge face.

“We try to consider every factor that can take away from a person’s health,” said Cassily. “HORSES is really working to alleviate these obstacles.”

A county in need

The county’s 2012 needs assessment determined that dental care was a top priority in the Rockbridge area. According to the assessment, 51 percent of area residents had not seen a dentist in the last two years. Healthy People 2020, a project by the federal government that outlines national health benchmarks, is working to increase the proportion of children, adolescents and adults who used the oral health care system in any previous 12 months.

HORSES last year reached 330 kids who do not have a home dentist, said Katy Datz, director of development and outreach at the health center.

Before HORSES began, the Free Clinic sent a dental team into local schools to teach students about basic dental hygiene.

Funding for HORSES came from organizations such as the Virginia Health Care Foundation, which allowed the health center to hire Cassilly; Delta Dental of Virginia; the Dominion Foundation, based in Richmond; the Gadsden Endowment based at R.E. Lee Memorial Church in Lexington; United Way of Rockbridge and Washington and Lee University.

This year, the program received a $41,000 grant from United Thank Offering, a charity funded by collection-plate giving at Episcopal churches nationwide. That allowed HORSES to purchase new equipment for placing sealants: a self-contained compressor unit that provides an air and water supply.

Datz said the clinic would like to acquire a second set of mobile equipment to increase the number of children Cassilly and her assistants are able to see.

The number of students examined, she said, varies at each clinic based on school and parental consent, but ranges from 10 to 50. Once parents give consent, Cassilly and her assistants arrive  with a mobile x-ray machine, mobile cleaning and examining equipment and a chair. They provide an exam, an x-ray, fluoride and sealants. If a child has a cavity or needs other dental care, he or she can arrange to be seen in the clinic off Route 11 opposite Lowe’s, north of Lexington.

For families covered through government insurance programs including Medicaid, Virginia’s Family Access to Medical Insurance Security program — or FAMIS — and FAMIS Plus, the health center bills the insurors directly. If a child does not have insurance and needs further treatment at the health center, the family is charged a small fee. About half the children seen in the schools don’t have Medicaid, Datz said.

Schooling young mouths

Cassilly said she has seen a lack of knowledge and understanding about dental hygiene among the kids.

“These children have a perpetuated fear of going to the dentist because often times their parents have serious dental issues and have phobias of their own,” Cassilly said. “They also don’t understand the procedures.”

Students at each visited school receive a tutorial about dental hygiene, even if their parents don’t want them to have the services provided by HORSES.

This spring, Cassilly expects to examine at least the same number of students as she examined last spring.

“There are a ton of statistics that show massive numbers of students missing school because of dental problems like toothaches,” she said. “When they get toothaches, they can’t sleep or eat, and they can’t focus in school.”

A rotten or missing tooth also affects a child’s self-esteem in school, and that can last for the rest of his or her life. Cassilly has seen it before.

One day recently, as she ushered a child into the dental office at the health center for his third follow-up appointment, she noticed something was different.

“The first time I saw him he was very scared and he didn’t know what to expect,” she said. “This time he jumped into the chair without hesitation.”

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